The document discusses the importance of restoring primary teeth in pediatric dentistry to manage caries, maintain function, and preserve aesthetics. It outlines the anatomical differences between primary and permanent teeth, along with various restorative material options such as composite resins, glass ionomers, and stainless steel crowns. Additionally, it emphasizes the factors influencing material choice, including the child's age, caries risk, and cooperation during procedures.

1. Restorative Dentistry
Pediatric Dentistry

2. Reasons for
Restoring
PrimaryTeeth
 Restore the damage caused by dental caries.
 Protect and preserve the remaining pulp and tooth structure;
thereby managing and preventing symptoms and pain.
 Retain adequate function.
 Restore aesthetics (where applicable).
 Facilitate easy maintenance of good oral hygiene.
 Maintain arch length and space for the developing permanent
dentition.

3. Anatomic
Differences
between the
Primary and
Permanent
Dentition
Anatomic Features of
PrimaryTeeth
Clinical Significance
Crown • Shorter
• Narrow OcclusalTable
• Thinner
Enamel/Dentin
• Marked Cervical
Constriction
• GenerallyWhiter
Shade
• Limited room for
cavity preparation
• Clinical caries only
detected if large
• Can be used to retain
a stainless steel crown
• More opaque and
whiter shade needed
Pulp • Larger relative to the
crown
• Pulp horns closer to
surface
• Limited room for
cavity preparation
• Higher Pulp exposure
chance
Roots • Longer and more
slender
• Flared
• Lots of accessory
canals
• Pulpectomy is difficult
due to root flare

4. Restorative MaterialChoices
 Composite Resins
 In the primary dentition, composite resins are increasingly used in combination with GICs in a ‘sandwich’-style aesthetic
restoration. Placement of these materials is highly technique-sensitive, and that patient compliance and adequate moisture
isolation can prove difficult in the younger, more challenging child.
 Glass IonomerCements
 A glass ionomer consists of a basic glass and an acidic water-soluble powder that sets by an acid–base reaction between the
two components. A principal benefit of GIC is that it will adhere chemically to dental hard tissues.
 Amalgam
 Historically the most popular due to how simple it is to manipulate, Amalgams have declined in use do to its unaesthetic
nature and potential for toxicity, and even more so on pediatric patients
 Stainless Steel Crowns
 Are preformed extra-coronal restorations that are particularly useful in the restoration of large multi-surface cavities and
grossly broken down teeth. They cover the entire clinical crown and therefore recurrent or further caries is very unlikely.

5. Advantages
and
Disadvantages
of Restorative
Materials for
PediatricUse
Advantages Disadvantages
Amalgam Simple,Quick and Cheap
Easy to manipulate
Durable
Not Adhesive
Occupational Hazard
Unaesthetic
Composite Adhesive
Aesthetic
Reasonable wear property
Command set
Technique sensitive
Needs proper isolation
Fairly expensive
Glass Ionomer Cement Adhesive
Aesthetic
Fluoride-releasing
Brittle
Susceptible to erosion
Technique sensitive
Stainless Steel Crowns Durable
Protect and support
remaining tooth structure
Extensive tooth
preparation
Unaesthetic

6. Choice of Material
 Age
 The age of the child will also dictate for how long a restoration is required to remain
satisfactory. A restoration in a first primary molar in a 9-year-old child does not require
the same durability as a restoration in a second primary molar in a 4-year-old child.
 Caries Risk
 Restorations in a child considered to be at high risk of caries may need to fulfill
different objectives from restorations in a low-risk child.
 Cooperation of the Child
 Many young children have behavior that is not conducive to perfect, textbook, cavity
preparation and restoration. In these cases, highly technique-sensitive procedures are
inappropriate.

7. Recommended
Material use in
Pediatric
Dentistry
Primary Dentition
Occlusal (Class I) Glass Ionomer Cement
Composite Resin
Amalgam
Proximal (Class II) Glass Ionomer Cement
Amalgam
Composite Resin – GIC (Sandwich)
Stainless Steel Crown
Gross Breakdown, or after Pulp
Treatment
Stainless Steel Crown
Permanent Dentition
OcclusalTable Fissure Sealant
Occlusal Enamel Caries Fissure Sealant
Occlusal Caries with Min. Dentin Preventive Resin Restoration
Occlusal Caries with Ext. Dentin Composite Resin
Interproximal Amalgam
Incisal Edge Composite Resin
Cervical Glass Ionomer Cement

8. Sealants
 Indications
 All permanent molars in children at medium or
high risk of caries. Premolars should be sealed in
those children at high risk.
 In children at low risk, only the fissures that are
deep and retentive need to be sealed.
 Primary posterior teeth in children at high risk of
caries.
 Sealants should be opaque so that they can be
detected by other clinicians. Use of clear sealants shows
stains in the fissures, which are most probably inactive
caries.
 Taking in to account individual caries risk, the use of
resin-based sealants is appropriate for fully erupted
molars or premolars.
 Glass ionomers are useful in high caries-active
individuals.The main problem with the use of GICs as
fissure sealants is the brittleness of the material when
used in thin section over the occlusal surface.

9. SealantMethod
1. Remove gross debris with a blunt probe and if
necessary, clean the occlusal surface with
pumice and water. And in most cases, like in the
Clinics, you will be required to perform Oral
Prophylaxis on the patient before sealant
application.
2. Etch the tooth with a gel etchant and wash
with water and dry with air irrigation.
3. If the tooth is contaminated it should be re-
etched.
4. Apply a thin coat of sealant to the pits and
fissures, making sure to include the buccal
extension on lower molars and the palatal
groove in upper molar teeth, then light-cure.

10. StainlessSteel
Crowns
 Indications
 Grossly broken down teeth
 Post-PulpTherapy PrimaryTeeth
 Hypo-plastic or Hypo-mineralized teeth
 High Risk andVery Uncooperative Pediatric Patients
 Stainless steel crowns provide the most durable restoration
for the primary dentition with survival times in excess of 40
months. Relatively expensive in relation to both time and
money in the short term. However, the rate of replacement of
these restorations is very low.

11. StainlessSteelCrownPrepand
Installation
1. Restore the tooth using a GIC or composite resin
prior to preparation for the stainless steel crown.
2. Reduce the occlusal surface by about 1.5 mm
using a flame-shaped or tapered diamond bur.
Uniform occlusal reduction will facilitate
placement of the crown without interfering with
the occlusion.
3. Using a fine, long, tapered diamond bur, cut
interproximal mesially and distally.The reduction
should allow a probe to be passed through the
contact area
4. Bucco-lingual reduction should be kept to a
minimum, as these surfaces are important for
retention.

12. StainlessSteelCrownPrepandInstallation
1. An appropriate size of a precontoured crown is
chosen by measuring the mesiodistal width.
2. A trial fit is carried out before cementation. It is
important that the crown should sit no more than 1
mm subgingivally. If there is excessive blanching of
the gingival tissues, the length of the crown should
be reduced and the margins should be smoothed
with a white stone.
3. Cement the crown with a GIC. Excess cement should
be wiped away and a layer ofVaseline placed around
the margins while the cement is setting.

13. Strip-off
Crown
 Composite is the material of choice for the restoration of
primary anterior teeth.When used in conjunction with
anterior strip crowns, composite resin provides an
aesthetic and durable restoration.

14. Strip-offCrown: Method
 1. Local anesthesia and rubber-dam isolation should be
used if possible.
 2. Select the correct celluloid crown form depending
on the mesiodistal width of the tooth
 3. Remove the caries using a slow-speed round bur
 4. Using a high-speed tapered diamond or tungsten
carbide bur, reduce the incisal height by around 2 mm,
prepare interproximal slices and place a labial groove at
the level of gingival and middle thirds of the crown.

15.  5. Protect the exposed dentine with a glass ionomer lining
cement
 6.Trim the crown form
 7. Etch the enamel for 20 s, wash and dry.
 8.Apply a thin layer of bonding resin and cure for 20 s, ensuring
all surfaces are covered equally.
 9. Fill the crown form with the appropriate shade of composite
and seat with gentle, even pressure, allowing the excess to exit
freely.The use of small wedges may be helpful in avoiding
interproximal excess.
 10. Light cure each aspect (labially, incisally and palatally)
equally.
 11. Remove the celluloid crown gently, and adjust the form and
finish with either composite finishing burs or abrasive discs.

16. Atraumatic Restorative
Treatment
 Atraumatic Restorative Treatment(ART)
is an alternative approach for managing
dental decay, which involves removal of
decayed tissue using hand instruments
alone, usually without the use of
anaesthesia (injected painkiller) and
electrical equipment.
 Revolves around the premise that once the
active carious tooth material is removed
and covered with an adhesive restorative
material, any remaining bacteria will be
arrested and would not progress.
 Removal of injections and drills is less
stressful to pediatric patients, and allows
for an easier approach in restorative
dentistry